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The opioid epidemic, with its noticeable increase in opioid prescriptions and related misuse, abuse and resultant deaths in the previous 12 years, is a particularly North American phenomenon. Europe, and particularly low- and middle-income countries, appear to be less influenced by this problem. There is undisputable value in using opioids not only in the treatment of acute pain, but in cancer pain as well. However, opioids are progressively being prescribed more and more for chronic non-cancer pain, despite inadequate data on their efficacy. In this paper, we describe the current prevalence of opioid misuse in a number of countries and the rationale for the commencement of opioid therapy. The safe initiation and monitoring of opioid therapy as well as the need for concurrent use of interdisciplinary multimodal therapy is discussed. The possible consequences of long-term use and predictors of high opioid use and overdose are presented. In particular, the management of opioid use disorders and the prevention of opioid abuse and dependence in the young, the old and the pregnant are discussed. Measures to prevent overprescribing and to alleviate risk are described, including the tapering of opioids and the use of opioid deterrents. Finally, the paper looks at the future development of pioneering medications and technologies to potentially treat abuse. In those parts of the world with an opioid epidemic, coroners and medical examiners, private and public health agencies, and agencies that enforce the law need to cooperate in an effort to slow down and reverse the indiscriminate use of prescribing opioids in the long-term for chronic non-cancer pain. Ongoing research is needed to create ways to minimise risks of opioid use, and to provide evidence for effective strategies for treating chronic pain.
Justice USDo. 2016 National drug threat assessment summary Washington (DC): Drug Enforcement Administration; 2016. Available from: https://www.dea.gov/resource-center/2016%20NDTA%20Summary.pdf.
Manchikanti L, Helm S, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV. Opioid epidemic in the United States. Pain Physician. 2012;15(3):9–38.
Drug overdose deaths in the United States continue to increase in 2015. Atlanta (GA): Centers for Disease Control and Prevention; 2016. Available from: https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed December 20, 2017.
CDC guideline for prescribing opioids for chronic pain—United States, 2016. Available at: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1. Accessed February 16, 2018.
Dispensing of prescription opioids in Canada has increased steadily since 2000, from 10,209 defined daily doses per million population per day in 2001–2003 to 30,540 in 2012–2014. International Narcotics Control Board (INCB) Narcotic drugs: estimated world requirements for 2004, statistics for 2002. United Nations Publication Sales. 2004;No.T:.16.XI.2.
International Narcotics Control Board (INCB) Narcotic drugs: estimated world requirements for 2016—statistics for 2014. United Nations Publication Sales. 2016;No. T:16.XI.2.
Busse JW, Craigie S, Juurlink DN, Buckley DN, Wang L, Couban RJ, Agoritsas T, Akl EA, Carrasco-Labra A, Cooper L, Cull C, da Costa BR, Frank JW, Grant G, Iorio A, Persaud N, Stern S, Tugwell P, Vandvik PO, Guyatt GH. Guideline for opioid therapy and chronic noncancer pain. CMAJ. 2017;189(18):E659–66. CrossRefPubMedPubMedCentral
International Narcotics Control Board (INCB). Report 2016 Narcotic drugs: estimated world requirements for 2017; statistics for 2015. United Nations Publications, New York; 2015. https://www.incb.org/incb/en/narcotic-drugs/Technical_Reports/narcotic_drugs_reports.html. Accessed April 12, 2017.
Faculty of Pain Medicine. Recommendations regarding the use of opioid analgesics in patients with chronic non-cancer pain—position statement. http://fpm.anzca.edu.au/documents/pm1-2010.pdf. Accessed December 20, 2017.
Werber A, Marschall U, L’hoest HW, Moradi B, Schiltenwolf M. Opioid therapy in the treatment of chronic pain conditions in Germany. Pain Physician. 2015;18(3):E323–31. PubMed
Jena AB, Goldman D, Weaver L, Karaca-Mandic P. Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims. BMJ. 2014;19(348):g1393. CrossRef
Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on drug use and health: summary of national findings, NSDUH, MD. Rockville: Substance Abuse and Mental Health Services Administration; 2014.
Els C, Jackson TD, Kunyk D, Lappi VG, Sonnenberg B, Hagtvedt R, Sharma S, Kolahdooz F, Straube S. Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;10:CD012509. PubMed
Centers for Disease Control and Prevention Public Health Service US Department of Health and Human Services. Guideline for prescribing opioids for chronic pain. J Pain Palliat Care Pharmacother. 2016;30(2):138–40. CrossRef
Manchikanti L, Abdi S, Atluri S, Balog CC, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: part 2—guidance. Pain Physician. 2012;15(3 Suppl):S67–116. PubMed
Ministry of Health New Zealand, available from https://www.health.govt.nz/search/results/opioid. Accessed December 20, 2017.
Manchikanti L, Abdi S, Atluri S, Balog CC, Benyamin RM, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: part I-evidence assessment American Society of Interventional Pain Physicians. Pain Physician. 2012;15(3 Suppl):1–65.
Agarin T, Trescot AM, Agarin A, Lesanics D, Decastro C. Reducing opioid analgesic deaths in America: what health providers can do. Pain Physician. 2015;18(3):E307–22. PubMed
Kahan M, Wilson L, Mailis-Gagnon A, Srivastava A, National Opioid Use Guideline Group. Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 2: special populations. Can Fam Physician. 2011;57(11):1269–76. PubMedPubMedCentral
Chou R, Gordon DB, de Leon- Casasola OA, Rosenberg JM, Bickler S, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, executive committee, and administrative council. J Pain. 2016;17:131–57. CrossRefPubMed
Kaiser U, Kopkow C, Deckert S, et al. Developing a core outcome-domain set to assessing effectiveness of interdisciplinary multimodal pain therapy: the VAPAIN consensus statement on core outcome-domains. Pain. 2018. https://doi.org/10.1097/j.pain.0000000000001129 (in press). PubMedCrossRef
Lee M, Silverman SM, Hansen H, et al. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145–61. PubMed
Low Y, Clarke CF, Huh BK. Opioid-induced hyperalgesia: a review of epidemiology, mechanisms and management. Singapore Med J. 2012;53(5):357–60. PubMed
Rivata C, Ballantyne J. The dark side of opioids in pain management: basic science explains clinical observation. Pain Rep. 2016;570:1–9.
Chou R, Deyo R, Devine B et al. The effectiveness and risks of long-term opioid treatment of chronic pain. Evidence report/technology assessment no. 218. (Prepared by the Pacific Northwest Evidence-based Practice Center under contract no. 290-2012-00014-I). AHRQ publication no. 14-E005- EF. Rockville, MD: Agency for Healthcare Research and Quality (2014). http://www.effectivehealthcare.ahrq.gov.
Peck KR, Ehrentraut JH, Anghelescu DL. Risk factors for opioid misuse in adolescents and young adults with focus on oncology setting. J Opioid Manag. 2016;12(3):2015–6.
Pain management and the opioid epidemic: balancing societal and individual benefits and risks of prescription opioid use. Consensus Report, National Academy of Sciences, July 2017.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States. MMWR Morb Mortal Wkly. 2016;65:1–49.
New Zealand Population Statistics. http://www.stats.govt.nz/browse_for_stats/population.aspx. Accessed March 21, 2017.
Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly. 2016;64(50–55):1378–82. CrossRef
IASP statement on opioids, February 2018. Available at: https://www.iasp-pain.org/Advocacy/OpioidPositionStatement. Accessed March 10, 2018.
- A Review of the Opioid Epidemic: What Do We Do About It?
Edward A. Shipton
Elspeth E. Shipton
Ashleigh J. Shipton
- Springer Healthcare
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